Clinton pivots to health care affordability

Hillary Clinton touted a plan Wednesday to address a growing concern among strapped middle-class voters: fast-rising out-of-pocket costs for those who have health coverage.

The plan is part of a broad package of changes she is rolling out this week that amount to Obamacare 2.0, pivoting from the divisive debate over expanding health care coverage to concerns about affordability and economic security uppermost in the minds of middle-class voters.

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Clinton’s proposal would expand on Obamacare coverage rules by requiring that insurers pay for at least three doctors’ visits for patients when they get sick. Currently, consumers can’t be charged for most preventive services, such as blood-pressure screenings and vaccinations, but most face steep deductibles when they go to the doctor because they’re sick.

“No one should have to worry about paying large out-of-pocket costs when they get sick and need a checkup during the year, whether it’s a common cold or a more harmful illness,” reads the proposal.

Clinton also proposes a refundable tax credit for Americans with health insurance who are still facing steep medical bills. The credit would be up to $2,500 for individuals and $5,000 for families and apply to individuals with health care costs exceeding 5 percent of their incomes.

The Democratic front-runner cited recent data from the Kaiser Family Foundation showing that deductibles on employer-based health plans have risen seven times faster than incomes for the average worker. Four out of five American workers are now enrolled in plans that require them to pay out of pocket before their coverage kicks in. That’s up from just over half a decade ago. The average deductible for American workers this year topped $1,300 — a jump of more than 40 percent over the last five years, according to the Kaiser data.

Recent polling data has shown that expensive drugs are now the top health care concern for voters — even topping Obamacare among Republican voters. Earlier this week, Clinton unveiled a proposal to address that concern, including a $250 monthly cap on out-of-pocket costs for prescription drugs, which sent the stock process of pharmaceutical companies plummeting. The insurance and pharmaceutical industries immediately criticized the plan as arbitrary and misguided.

Her top rival for the Democratic nomination, Vermont Sen. Bernie Sanders, has touted his own plan to tackle runaway drug prices.

But out-of-pocket costs could also have political salience as the health care debate evolves beyond Obamacare.

“As the ACA begins to cool at least a little bit as a political issue, it creates an opportunity for new health issues to fill the void,” said Drew Altman, president of the Kaiser Family Foundation.

Clinton’s proposal also addresses “surprise” medical bills, which have become an increasingly thorny problem as health plans with narrow provider networks become more common. Patients who visit in-network facilities for surgery, for instance, sometimes unwittingly receive services from a doctor who is not part of their network and end up with steep bills. Her plan would prohibit providers from charging at out-of-network rates when a patient visits a facility covered by their insurance plan.

Clinton also promises to bolster the ability of the federal government to stop unreasonable rate hikes for consumers and increase transparency so that shoppers know what they’re getting when they choose a health plan.

In addition, Clinton promises to vigorously enforce anti-trust laws. A pair of blockbuster insurance mergers worth nearly $100 billion have triggered concerns that consolidation could erode the ACA’s promise of increased competition in the insurance marketplace.

“It’s a fairly sensible, not terribly radical proposal,” said Timothy Jost, professor emeritus at Washington and Lee School of Law and a supporter of the ACA.

But Altman points out that by laying out a detailed proposal, it could open Clinton up to criticism. Most Republicans have shied away from offering any concrete details for how they would repeal and replace the ACA.

“It has a lot of parts,” Altman said. “When you have a lot of parts and components, they can also be targets for criticism.”

Clinton’s proposals constitute a break from the last three election cycles, when Democrats largely sought to avoid talking about the landmark health care law on the campaign trail. That allowed Republicans to pillory the controversial — and still broadly unpopular law — largely without rebuttal.

“In the past it’s been mostly duck and cover,” said Larry Jacobs, a political science professor at the University of Minnesota.

Jacobs argues that it will set up a stark contrast with the positions of the eventual Republican nominee.

“Hillary Clinton’s all in,” on the ACA, he said. “Republicans are going to go in the other direction, criticizing the ACA as a government overreach. So we’re looking at a very sharp choice.”